Dual-energy CT biomarkers for predicting the efficacy of TACE combined with lenvatinib and immune checkpoint inhibitors in unresectable HCC.

Although transcatheter arterial chemoembolization (TACE) is one of the first-line treatments for unresectable HCC (uHCC) patients, its overall efficacy varies significantly. Therefore, the identification of reliable biomarkers capable of effectively distinguishing TACE-responsive populations is clinically critical. Our research aims to investigate T-lymphocyte subpopulations and associated pathways in peripheral blood that contribute to TACE refractoriness, as well as to develop effective methods for predicting TACE efficacy. This is an observational study. A total of 50 patients who underwent standard TACE-based therapy between January 2020 and December 2022 were included in this study. TACE response was evaluated within 1-3 months following two consecutive TACE sessions. Patients with TACE failure were assigned to the Non-Response group, whereas the remaining were categorized into the Response group. Blood samples were collected prior to treatment and subsequently analyzed using flow cytometry and RNA sequencing. Predictors were analyzed using univariate and multivariate analyses within the bivariate logistic regression models. Pathway enrichment analysis was performed using gene set enrichment analysis (GSEA). A total of 24 of 50 (48%) exhibited TACE failure (Non-Response). Baseline peripheral T-lymphocyte analysis revealed that the Non-Response group had a higher abundance of senescent phenotype (TSenescence, CD27-CD28-) in both CD4/CD8+ T cells (p < 0.0001), but a lower proportion of memory stem cell (TSCM) subpopulation (CD4+ TSCM: p = 0.0411; CD8+ TSCM: p < 0.0001). Furthermore, in CD8+ T cells, they exhibited higher expression of exhaustion marks (PD-1: p = 0.0005; LAG-3: p = 0.0026; TIGIT: p = 0.0014) and significantly lower production of effector molecules (TNF-α: p < 0.0001; IFN-γ: p = 0.0018; GZMB: p < 0.0001). Transcriptomics revealed that the Response group was enriched in pathways associated with energy and drug metabolism. Univariate and multivariate analyses demonstrated that the baseline CD8+ TSCM and CD8+ TSenescence subpopulations were significant predictive factors for TACE efficacy. Our study demonstrated significant differences in the immune characteristics of peripheral T lymphocytes between the Non-Response and Response groups. The CD8+ TSCM and CD8+ TSenescence subsets are potential predictors of TACE efficacy and long-term survival. These insights into peripheral blood T lymphocytes offer valuable evidence to help clinicians more effectively identify potential TACE-responsive populations, predict survival, and develop personalized treatment regimens for patients with uHCC.

558 Background: Transarterial chemoembolization (TACE) is one of the standard treatments for patients with intermediate-stage hepatocellular carcinoma (HCC). The combination of immune checkpoint inhibitors (ICIs) and lenvatinib has shown to be an effective regimen in patients with unresectable HCC (uHCC). In this study, we aim to investigate the efficacy and safety of combination of Envafolimab (a novel, single-domain PD-L1 antibody) with Lenvatinib plus TACE in uHCC patients. Methods: This is a prospective, open-label, single-arm, phase 2 study. Adults with confirmed uHCC with BCLC stage B or C, Eastern Cooperative Oncology Group performance status 0 or 1, Child–Pugh scored ≤7 and no previous systemic treatment for HCC are eligible. Patients will receive Lenvatinib once daily plus Envafolimab every 3 weeks plus TACE. TACE will be conducted repeatedly every 6 weeks on demand according to investigators’ consideration, mainly based on the proportion of viable tumors. Imaging evaluation will be conducted every 6 weeks. The primary endpoint is objective response rate (ORR). Disease control rate (DCR), duration of response (DoR), progression free survival (PFS), overall survival (OS) and safety are evaluated as secondary endpoints (NCT05213221). Results: forty patients were consecutively enrolled from March, 2022 to September 2022. The median age was 54.5 years. At present, thirty-six patients were included for efficacy analysis, and forty for safety evaluation. Number of patients with BCLC stage B and C was 17(47.2%) and 19 (52.8%), respectively. 13 (36.1%) patients presented with portal vein tumor thrombus (PVTT) and 2 (5.6%) patient presented with hepatic vein tumor thrombus (HVTT). The ORR was 36.1% and 80.6%, and DCR was 77.8% and 83.3%, based on RECIST v1.1 and modified RECIST respectively. 11 patients reached the standard of conversion to resectable HCC and received radical resection. The most common TRAEs were elevated AST (75%), elevated ALT (65%) and leukopenia (42.5%). No treatment-related deaths occurred. The survival data are not mature at present. Conclusions: Envafolimab plus Lenvatinib combined with TACE is a promising and tolerable therapeutic regimen for patients with BCLC B/C unresectable HCC. Clinical trial information: NCT05213221 .

e16138 Background: Hepatocellular carcinoma (HCC) has the third-highest cancer-related mortality rate in the world because most patients are diagnosed at an intermediate to advanced stage when surgery is not suitable. Transcatheter arterial chemoembolization (TACE) is currently considered a first-line therapy for unresectable HCC (uHCC), while the efficacy of TACE alone for uHCC patients still needs to be improved. Anlotinib has shown survival benefits in the treatment of uHCC as a kind of novel tyrosine kinase inhibitors (TKIs) in previous studies. Therefore, we aimed to compare clinical outcomes of TACE combined with anlotinib versus TACE monotherapy in patients with uHCC associated with hepatitis B virus (HBV). Methods: We retrospectively collected the data of 96 uHCC patients associated with hepatitis B virus who received either TACE only (TO group; n = 64) or anlotinib combined with TACE (TA group; n = 32) between January 2017 to January 2021. The clinical outcomes including overall survival (OS), progression-free survival (PFS), and tumor response according to mRECIST and RECIST 1.1 were compared between the two groups. Adverse events (AEs) were analyzed to assess the safety profiles. Results: The median OS in the TA group was 17.6 months (95%CI, 11.3 to 24.3) versus 9.4 months (95% CI, 7.8 to 16.3) in the TO group (hazard ratio, 0.59; 95% CI, 0.39 to 0.90; p= 0.018). The median PFS was also significant longer in the TA group (6.7 vs. 3.8months; hazard ratio, 0.46; p&lt; 0.001). Additionally, the objective response rate (ORR) and disease control rate (DCR) numerically increased in the TA group (mRECIST: ORR 65.6% vs. 46.9%, p= 0.064; DCR 90.6% vs. 85.9%, p= 0.382. RECIST 1.1: ORR 46.9% vs. 15.6%, p= 0.001; DCR 90.6% vs. 85.9%, p= 0.382; respectively). No treatment-related mortality occurred. The most common AEs included elevated transaminases (56.3%), decreased appetite (46.9%) and abdominal pain (37.5%) in TA group. Though the incidence rate of grade 3/4 was higher in TA group, all of them were acceptable and controllable. Conclusions: Anlotinib combined with TACE may significantly improve outcomes for uHCC patients associated with hepatitis B virus comparing with TACE monotherapy with a controllable safety profile. Randomized controlled trials with a large sample are warranted to further validate the efficacy.

54 Background: Hepatocellular carcinoma (HCC) is characterized by hypovascularity, the efficacy of transcatheter arterial chemoembolization (TACE) has been suboptimal. This study sought to evaluate and compare the efficacy and safety profiles of cryoablation (CRYO) plus lenvatinib (LEN) against TACE plus LEN for unresectable hepatocellular carcinoma (u-HCC) patients within a real-world clinical practice. Methods: A prospective study was conducted involving 234 patients with u-HCC who underwent treatment with LEN plus either CRYO or TACE at the Fifth Medical Center of the Chinese PLA General Hospital from October 2018 to May 2023. Treatment selection was determined through multidisciplinary discussions among a liver cancer board, weighing the pros and cons. The final decision was made by the patients and clinicians based on consensus. Clinical characteristics were balanced using propensity score matching (PSM). The primary endpoint was overall survival (OS), while secondary endpoints included progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs). Tumor response was based on RECIST v1.1 and mRECIST by blinded independent imaging review, AEs by CTCAE v5.0. Results: In this study, 212 (90.6%) were male, with an average age of 56 years. 206 (88%) patients were infected with hepatitis B virus (HBV), and 178 (76.1%) and 77 (32.9%) patients were classified as Child-Pugh A and BCLC B. After PSM, the clinical characteristics were comparable between the CRYO plus LEN and the TACE plus LEN group. Over a median follow-up of 31.8 months, 124 patients (53%) died. The CRYO plus LEN group demonstrated similar OS (24.2 vs. 22.0 months, P = 0.64), PFS (8.7 vs. 11.9 months, P = 0.48), ORR (53.1% vs. 53.1%, P = 1.00), and DCR (86.5% vs. 78.1%, P = 0.19) compared to the TACE plus LEN group after PSM, with consistent results observed before PSM. The two groups exhibited comparable AEs. In addition to similar LEN-related AEs, the most common CRYO-related AEs included 50% elevated ALT, 50% elevated AST, and 38.5% fever, which were consistent with the TACE related AEs. Notably, the incidence of abdominal pain was higher in the TACE plus LEN group compared to the CRYO plus LEN group (7.5% vs. 0.8%, P = 0.021), while pleural effusion was more prevalent in the CRYO plus LEN group than that in the TACE plus LEN group (6.2% vs. 0, P = 0.038). Conclusions: The CRYO plus LEN group exhibited comparable efficacy and well-tolerated safety with TACE plus LEN for u-HCC patients within a real-world clinical setting. It offers a viable alternative for HCC characterized by hypovascularity, presenting a promising therapeutic approach in the clinical management of u-HCC. Clinical trial information: ChiCTR2200058643 .

e16133 Background: Based on the different anti-malignant mechanisms of tyrosine kinase inhibitors (TKIs), immune checkpoint inhibitors (ICIs) and transarterial therapy, several studies have demonstrated the potential of combining these three treatments to improve outcomes in patients with unresectable hepatocellular carcinoma (uHCC). This study aimed to evaluate the efficacy and safety of transarterial therapy plus donafenib and ICIs for uHCC patients in a real-world setting. Methods: This multicenter retrospective study included patients with uHCC who had received at least one cycle of transarterial therapy (hepatic arterial infusion chemotherapy, HAIC, or transarterial chemoembolization, TACE) and donafenib and ICIs (anti-PD-1 available in China) at five cancer centers. Other key inclusion criteria were: (1) no prior systemic treatment; (2) at least one follow-up image data. The primary endpoint was progression-free survival (PFS) according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Secondary endpoints included overall survival (OS), objective response rate (ORR) and toxicity. Results: Of the 61 eligible patients enrolled, 56 (91.8%) were men, 54 (88.5%) had HBV infection, 26 (42.6%) had AFP level &gt; 400 ng/mL, 38 (62.3%) were at BCLC stage C, 32 (52.5%) had macrovascular invasion, 14 (23.0%) had extrahepatic metastasis, 47 (77.0%) had multiple tumors and the median maximum tumor size was 86.0 mm (IQR, 61.5–122.6). Four kinds of ICIs were employed, including tislelizumab (n = 29), camrelizumab (n = 21), sintilimab (n = 9), toripalimab (n = 2). Up to the date of November 24, 2023, the median follow-up time was 13.0 months. The median PFS was 12.7 months (95%CI, 8.4–NA), with a 1-year PFS rate of 52.7% (95%CI, 37.9%–73.1%). The median OS was not reached, and 1-year OS rate was 88.4% (95%CI, 79.9%–97.8%). The ORR according to mRECIST was 70.5%. Twelve (19.7%) patients had received conversion resection, and the median conversion time was 3.1 months (95%CI, 2.37–NA). Overall, 51 (83.6%) patients experienced at least one treatment-related adverse events (TRAEs), 22 (36.1%) had grade 3 or 4 AEs, and no patients died due to AEs. The most common AEs greater than 15% were hand-foot skin reaction (47.5%), liver dysfunction (27.9%), decreased platelet count (19.7%) and hypoalbuminemia (16.4%). Conclusions: This retrospective real-world study showed that transarterial therapy combined with donafenib plus ICIs in the treatment of uHCC patients was well tolerated and comparable clinical efficacy to other triple therapies. This combination strategy may be an appropriate treatment option for uHCC patients.

Hepatocellular carcinoma (HCC) remains a global challenge due to its high morbidity and mortality rates as well as poor response to treatment. Local combined systemic therapy is widely used in the treatment of unresectable hepatocellular cancer (uHCC). This retrospective study was to investigate the prognostic effect and prognostic factors of transcatheter arterial chemoembolization (TACE) plus tyrosine kinase inhibitors (TKI) with immune checkpoint inhibitors (ICIs) in the treatment of uHCC. A retrospective analysis of 171 patients with uHCC was performed in our hospital from April 27, 2015 to October 18, 2021. According to different treatment options, patients were divided into TACE group (n=45), TACE+TKI group (n=76) and TACE+TKI+ICIs group (n=50). In this study, we found that, the median overall survival (mOS) of TACE+TKI+ICIs group was significantly better than TACE+TKI group and TACE group [24.1 (95% CI 15.1-33.1) months vs 14.9 (95% CI 10.7-19.1) months vs 11.4 (95% CI 8.4-14.5) months, hazard ratio (HR) 0.62; 95% CI 0.47-0.81; P=0.002]. A visible difference in the median progression-free survival (mPFS) interval between the groups was discovered [10.6 (95% CI6.5-14.7) months in TACE+TKI+ICIs group vs. 6.7 (95% CI 5.5-7.9) months in the TACE+TKI group vs. 6 (95% CI 2.3-9.7) months in the TACE group (HR 0.66; 95% CI 0.53-0.83; P<0.001)]. The objective response rates (ORR) in the TACE group, TACE+TKI group, and TACE+TKI+ICIs group were 31.1%, 35.5%, and 42%, and the disease control rate (DCR) were 51.1%, 65.8%, and 80%. There were no adverse events (AEs) of arthralgia, diarrhea, rash, and pruritus in the TACE group. The incidence of grade 3 AEs (Hypertension) in the TACE+TKI+ICIs group was significantly higher than that in TACE+TKI and TACE groups (28% vs 17.1% vs 6.7%, P=0.024), and secondly, the morbidity of rash and pruritus in the TACE+TKI+ICIs group was apparently higher than that in the TACE+TKI group (P<0.05). Multivariate analysis showed that ECOG-PS 2 (HR=2.064, 95%CI 1.335-3.191, P=0.001), Hepatitis B virus (HR=2.539, 95%CI 1.291-4.993, P=0.007), AFP≥400 ng/ml (HR= 1.72, 95%CI 1.12-2.643, P=0.013), neutrophil-lymphocyte ratio (NLR) ≥2.195 (HR=1.669, 95%CI 1.073-2.597, P=0.023) were independent risk factors for OS in uHCC patients. So, TACE+TKI+ICIs therapy can prolong the OS and improve the prognosis of patients effectively, with a well-characterized safety profile.

Simple SummaryAtezolizumab plus bevacizumab has been approved as the first-line systemic treatment for unresectable hepatocellular carcinoma (uHCC) patients. However, the real-world practice of this combination is limited. We reported 48 uHCC patients who received atezolizumab plus bevacizumab, the median progression-free survival (PFS) was 5.0 months, and the objective response rate and disease control rate were 27.1% and 68.8%, respectively. The severity of most adverse events was predominantly grade 1–2, and most patients tolerated the toxicities. We also used inflammatory biomarkers to predict PFS, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Univariate and multivariate analyses revealed NLR and PLR were independent prognostic factors for superior PFS. The significance of our study is the first research to investigate the prognostic value of NLR and PLR among uHCC patients receiving atezolizumab plus bevacizumab. It would bring more information to physicians about the efficacy and safety of atezolizumab plus bevacizumab in real-world clinical practice.Atezolizumab plus bevacizumab has been approved as the first-line systemic treatment for patients with unresectable hepatocellular carcinoma (uHCC). This study was designed to assess the clinical impact of atezolizumab plus bevacizumab in uHCC patients. A total of 48 uHCC patients receiving atezolizumab plus bevacizumab were identified, including first-line, second-line, third-line, and later-line settings. In these patients, the median progression-free survival (PFS) was 5.0 months, including 5.0 months for the first-line treatment, not reached for the second-line treatment, and 2.5 months for the third line and later line treatment. The objective response rate and disease control rate to atezolizumab plus bevacizumab were 27.1% and 68.8%, respectively. The severity of most adverse events was predominantly grade 1–2, and most patients tolerated the toxicities. The ratios of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte (PLR) were used to predict PFS in these patients. The optimal cutoff values of NLR and PLR were 3 and 230, and NLR and PLR were independent prognostic factors for superior PFS in the univariate and multivariate analyses. Our study confirms the efficacy and safety of atezolizumab plus bevacizumab in uHCC patients in clinical practice and demonstrates the prognostic role of NLR and PLR for PFS in these patients.

ObjectivesThis study aimed to investigate the ability of quantitative parameters of dual-energy computed tomography (DECT) and nodule size for differentiation between lung cancers and benign lesions in solid pulmonary nodules.Materials and MethodsA total of 151 pathologically confirmed solid pulmonary nodules including 78 lung cancers and 73 benign lesions from 147 patients were consecutively and retrospectively enrolled who underwent dual-phase contrast-enhanced DECT. The following features were analyzed: diameter, volume, Lung CT Screening Reporting and Data System (Lung-RADS) categorization, and DECT-derived quantitative parameters including effective atomic number (Zeff), iodine concentration (IC), and normalized iodine concentration (NIC) in arterial and venous phases. Multivariable logistic regression analysis was used to build a combined model. The diagnostic performance was assessed by area under curve (AUC) of receiver operating characteristic curve, sensitivity, and specificity.ResultsThe independent factors for differentiating lung cancers from benign solid pulmonary nodules included diameter, Lung-RADS categorization of diameter, volume, Zeff in arterial phase (Zeff_A), IC in arterial phase (IC_A), NIC in arterial phase (NIC_A), Zeff in venous phase (Zeff_V), IC in venous phase (IC_V), and NIC in venous phase (NIC_V) (all P < 0.05). The IC_V, NIC_V, and combined model consisting of diameter and NIC_V showed good diagnostic performance with AUCs of 0.891, 0.888, and 0.893, which were superior to the diameter, Lung-RADS categorization of diameter, volume, Zeff_A, and Zeff_V (all P < 0.001). The sensitivities of IC_V, NIC_V, and combined model were higher than those of IC_A and NIC_A (all P < 0.001). The combined model did not increase the AUCs compared with IC_V (P = 0.869) or NIC_V (P = 0.633).ConclusionThe DECT-derived IC_V and NIC_V may be useful in differentiating lung cancers from benign lesions in solid pulmonary nodules.

Few reliable biomarkers for predicting the efficacy of triple therapy (lenvatinib + immune checkpoint inhibitors + transarterial chemoembolization) exist for patients with unresectable hepatocellular carcinoma (uHCC). This study explored the prognostic role of alpha-fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP) levels in patients with uHCC receiving triple therapy. This retrospective study included 93 patients with uHCC who received triple therapy at Fujian Provincial Hospital between August 2020 and November 2022. Depending on the respective baseline levels, the patients were divided into high-AFP and high-DCP groups. An early response was defined as an AFP or DCP concentration >50% less than the baseline concentration after 6 weeks of triple therapy. The primary endpoint was the objective response rate (ORR). The secondary endpoints were progression-free survival (PFS) and overall survival (OS). After 6 weeks of triple therapy, 75.3% (58/77) and 78.9% (60/76) of patients in the high-AFP and high-DCP groups achieved an objective response. Early AFP and DCP responses were positively associated with ORR (high-AFP group: odds ratio [OR]: 13.542; 95% confidence interval [CI]: 3.991-45.950, p<0.001; high-DCP group: OR: 17.853; 95% CI: 4.478-71.179, p<0.001). In the high-AFP group, the 6-month, 12-month, and 18-month PFS and OS rates were higher in the AFP responders than those in the non-responders (PFS: 66.4%, 59.6%, 48.2% vs 42.3%, 19.3%, 0%, p<0.001; OS: 94.5%, 90.4%, 77.3% vs 75.6%, 66.2%, 49.6%, p=0.006). In the high-DCP group, the 6-month, 12-month, and 18-month PFS and OS rates were higher in the DCP responders than those in the non-responders (PFS: 67.4%, 57.7%, 39.0% vs 38.9%, 8.1%, 0%, p<0.001; OS: 94.7%, 94.7%, 83.3% vs 77.0%, 53.9%, 36.0%, p<0.001). After 6 weeks of triple therapy, an AFP or DCP reduction of >50% predicts better treatment outcomes in uHCC patients.

Lung cancer continues to pose a serious risk to human health. With a high mortality rate, non-small cell lung cancer (NSCLC) is the major type of lung cancer, making up to 85% of all cases of lung cancer. Lung adenocarcinoma (AC), and lung squamous cell carcinoma (SC) are the two primary types of NSCLC. Determining the pathological type of NSCLC is important in establishing the most effective treatment method. Dual-energy computed tomography (DECT) multi-parameter imaging is an imaging technology that provides accurate and reliable disease diagnosis, and its uses are utilized for the combined diagnostic efficacy of AC and SC. The purpose of this study was to investigate the diagnostic value of spectral parameters of DECT in efficacy to AC and SC, and their combined diagnostic efficacy was also analyzed. We conducted a retrospective analysis of clinical and imaging data for 36 patients diagnosed with SC and 35 patients with AC. These patients underwent preoperative DECT chest scans, encompassing both arterial and venous phases, at our hospital from December 2020 to April 2022. The tumor diameter, water concentration (WC), iodine concentration (IC), normalized iodine concentration (NIC), Z effective (Zeff), and slope of the curve (K) in lesions were evaluated during two scanning phases in the two separate pathological types of lung cancers. The differences in parameters between these two types of lung cancers were statistically analyzed. In addition, receiver operating characteristic (ROC) curves were performed for these parameters to distinguish between SC and AC. In a univariate analysis involving 71 lung cancer patients, the results from Zeff, IC, NIC, and K from the AC's arterial and venous phase images were more elevated than those from the SC (P < 0.05). In contrast, the WC results were lower than those from SC (P < 0.05). The area under the ROC curve (AUC) for multi-parameter joint prediction typing was 0.831, with a corresponding sensitivity of 63.9% and specificity of 94.3%. It is possible to distinguish between central SC and AC using the spectrum characteristics of DECT-enhanced scanning (Zeff, IC, NIC, K, WC, and tumor diameter). Diagnostic effectiveness can be greatly improved when multiple variables are included.

To assess the relationship between clinical prognosis and changes of skeletal muscle mass for unresectable hepatocellular carcinoma (uHCC) patients who received transarterial chemoembolization (TACE) with molecular-targeted agents and immune checkpoint inhibitors (TACE-MTAs-ICIs). From June 2019 to June 2023, a total of 92 uHCC patients who received TACE-MTAs-ICIs therapy were included. Skeletal muscle mass was assessed before and 6 months after treatment. Skeletal muscle index (SMI) is calculated as skeletal muscle area at the L3 vertebra divided by the square of height, then the change rate of SMI (ΔSMI) is calculated. Patients were stratified based on ΔSMI as muscle gain and non-muscle gain groups. Overall survival (OS) was compared between groups and prognostic factors for OS were analyzed. Progression-free survival (PFS) was also recorded. The median OS in the muscle gain group was significantly longer than that in the non-muscle gain group (Not reach vs 25.2 months, P < 0.001). The median PFS did not reach significant between two groups (16.2 vs 9.1 months, P = 0.101). Multivariate analyses revealed that skeletal muscle gain (HR = 0.20; 95% CI, 0.06-0.68; P = 0.010) and Barcelona Clinic Liver Cancer stage (HR = 1.94; 95% CI, 1.02-3.69; P = 0.044) were independent prognostic factors for OS. SMI increment appeared as a favorable predictor for these uHCC patients who received TACE-MTAs-ICIs therapy.

SIB-IMRT combined with apatinib for unresectable hepatocellular carcinoma in patients with poor response to transarterial chemoembolization

Evaluation of Quantitative Dual-Energy Computed Tomography Parameters for Differentiation of Parotid Gland Tumors

Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality. Accurate differentiation of tumor grade is crucial for prognosis and treatment planning. This study aimed to evaluate the diagnostic value of dual-source CT dual-energy technology parameters in distinguishing CRC differentiation grades. A retrospective analysis was conducted on 87 surgically and pathologically confirmed CRC patients (64 with medium-high differentiation and 23 with low differentiation) who underwent dual-source CT dual-energy enhancement scanning. Normalized iodine concentration (NIC), spectral curve slope (K), and dual-energy index (DEI) of the tumor center were measured in arterial and venous phases. Differences in these parameters between differentiation groups were compared, and ROC curve analysis was performed to assess diagnostic efficacy. The low-differentiation group exhibited significantly higher NIC, K, and DEI values in both arterial and venous phases compared to the mediumhigh differentiation group (P < 0.01). In the arterial phase, NIC, K, and DEI yielded AUC values of 0.920, 0.770, and 0.903, respectively, with sensitivities of 95.7%, 65.2%, and 91.3%, and specificities of 82.8%, 75.0%, and 75.0%, respectively. In the venous phase, AUC values were 0.874, 0.837, and 0.886, with sensitivities of 91.3%, 82.6%, and 91.3%, and specificities of 68.75%, 75.0%, and 73.4%. NIC in the arterial phase showed statistically superior diagnostic performance compared to K values (P < 0.05). Dual-energy CT parameters, particularly NIC in the arterial phase, demonstrate high diagnostic accuracy in differentiating CRC grades. These findings suggest that quantitative dual-energy CT metrics can serve as valuable non-invasive tools for tumor characterization, aiding in clinical decision-making. Study limitations include its retrospective design and relatively small sample size. NIC, K, and DEI values in dual-energy CT scans are highly effective in distinguishing CRC differentiation grades, with arterial-phase NIC showing the highest diagnostic performance. These parameters may enhance preoperative assessment and personalized treatment strategies for CRC patients.

This study aimed to assess the efficacy of quantitative parameters derived from dual-energy computed tomography (DECT) for the preoperative prediction of early recurrence (ER) in patients with esophageal squamous cell carcinoma (ESCC). In total, 78 patients with ESCC who underwent radical esophagectomy and DECT from June 2019 to August 2020 were enrolled in this study. Normalized iodine concentration (NIC) and electron density (Rho) in tumors were measured using arterial and venous phase images, whereas unenhanced images were used to determine the effective atomic number (Zeff). Univariate and multivariate Cox proportional hazards models were used to identify independent risk predictors of ER. Receiver operating characteristic curve analysis was performed using the independent risk predictors. ER-free survival curves were constructed using the Kaplan-Meier method. NIC in the arterial phase (A-NIC; hazards ratio [HR], 3.91; 95% confidence interval [CI], 1.79-8.56; p = 0.001) and pathological grade (PG; HR, 2.69; 95% CI, 1.32-5.49; p = 0.007) were identified as significant risk predictors of ER. The area under the curve of A-NIC for predicting ER in patients with ESCC was not significantly higher than that of PG (0.72 vs. 0.66, p = 0.441). In a stratified survival analysis, patients with high A-NIC or poorly differentiated ESCC had a higher rate of ER than those with low A-NIC or highly/moderately differentiated ESCC. A-NIC derived from DECT can be used to noninvasively predict preoperative ER in patients with ESCC, with an efficacy comparable to that of pathological grade. Preoperative quantitative measurement of dual-energy CT parameters can predict the early recurrence of esophageal squamous cell carcinoma and serve as an independent prognostic factor to guide clinical designation of personalized treatment. • Normalized iodine concentration in the arterial phase and pathological grade were independent risk predictors of early recurrence in patients with esophageal squamous cell carcinoma. • Normalized iodine concentration in the arterial phase may be a noninvasive imaging marker for preoperatively predicting early recurrence in patients with esophageal squamous cell carcinoma. • The efficacy of normalized iodine concentration in the arterial phase derived from dual-energy computed tomography for predicting early recurrence is comparable to that of pathological grade.